U.S. Healthcare Has Lost It’s Center. Can We Re-Center It?

“I’ll just go where insurance tells me to go.” So ended a recent conversation with my 84-year-old mother-in-law as she told us about her effort to get a brace prescribed for her by her physician and the requirement that she drive an hour to the correct point of access for the product she needed. One might think it was a special order item or something with limited access or simply a factor of her living remotely. It was not a special item or limited in availability, and she had already driven an hour into the city for the medical appointment. She drove another hour past a dozen other access points because Medicare dictated it.

On the surface, it’s a little thing. After all, we’re all used to running around to take care of our healthcare needs. The mind-blowing thing to observe in this small snapshot of our system is that every step along her journey has been the same experience. Once she entered the system to try to address the onset of a debilitating source of pain, the blocking, herding, denying, delaying, and confusing began. Fortunately for her, the care has been good but the gyrations to address the physical pain create an almost equal amount of pain in frustration and uncertainty.

Nobody reading this needs me to convince them that there are myriad problems with our current system of healthcare in the United States. Stories abound and a quick search will produce far more and far worse stories. The first part of the title for this post is actually misleading as American healthcare has a very specific center – it’s just not the patient. What’s at our healthcare center? “Insurance.”

When my mother-in-law says “insurance,” she’s talking about the massive bureaucracies administering our healthcare system. For most of our country, this means the federal government or the handful of health plans that dominate our healthcare landscape – including being the largest employers of physicians in the country. These aren’t your local hospitals, a group frequently demonized for high prices or price obfuscation. No, it’s the BUCAH industrial complex that controls the networks, sets the prices, and herds all of us through the byzantine maze of hoops, hurdles, pits, and corrals that surround and encompass our healthcare system.

Not sure what “BUCAH” means? Do a quick Google search and you’ll see. They are the center of our American healthcare universe and they are the ones dictating the care you receive and don’t receive, where and how you receive it, as well as how much you pay for it. We live in a mass production healthcare universe that isn’t made to produce health but instead made to administer, throttle, and capture value, from transactional healthcare. In this world, the patient is far from the center, as he or she sits in his or her own personal orbit around the cold, faceless, titanic, center we call “insurance.”

This post isn’t the place to recount how we got here and none of us needs another collection of frustrating healthcare stories. My mother-in-law’s anecdote is annoyingly basic, however, there are plenty of life and death versions to stoke more serious flames of angst. Unless you work within the industrial BUCAH complex or reap their rewards as an investor, you likely recognize and freely admit where the center of gravity sits in the U.S. healthcare system as well as its problems. It is working as it’s designed and is actually pretty effective at herding us and capturing value for itself.

This post is concerned with two questions: Is it too late to re-center it? And, if not, how do we do it?

In a few weeks, I’ll be speaking to a room of health system executives on ideas to “reduce the footprint of Goliath.” Wait, aren’t health systems part of the problem? Hospitals have taken a beating over pricing and their part in our healthcare mess but we need to recognize that they are orbiting the same center. Health systems are as beholden to the health plan industrial complex as we are as individuals. The plan sets the price. The plan dictates care through prior authorizations, cost-sharing, steerage, contract gag clauses, rebate manipulation, lobbying, setting below cost reimbursements, and a variety of other practices that make things difficult for providers and patients alike.

My message to my audience? We need to put the patient back at the center. We need to focus on the total healthcare experience: access, cost, and complexity. Where does this begin? It begins with the lowest common denominator: the human being. It begins in that person’s community. It begins with that person’s employer. It begins with where and how that person accesses and pays for healthcare as well as how he/she experiences it. It begins with an obsessive focus on what creates individual human flourishing.

We’ve gotten so consumed with pulling the big levers, moving the big herds, and administering the huge populations, that we’ve lost sight of the individual we’re trying to serve. Who can change this? The employer, the union, and the local healthcare providers. How? By deconstructing the entrenched systems that fix us into our current orbit. We have to shrink Goliath’s footprint, and stranglehold, on our $4.5 trillion dollar healthcare economy. We have to move them from the center.

Does it sound too big? Does it seem impossible? It’s already happening. Ice is melting at the edges. There is no silver bullet fix, nor is there a “fast pass” to a better future. It is going to take time, focus, discipline, fortitude, and significant energy. It starts with a vision for something better and innovative thinking on how to bridge to it in a world so beholden to its current center. It is not about government regulation but a free market that moves thing by moral and economic force. Re-centering on the patient is pragmatic, morally appropriate, and necessary. It will begin with self-funded employers and unions, working with local health systems, and leveraging competitive market forces.

Curiously, once we start re-centering on the individual, we’ll find that it pulls the healthcare provider and the commercial payer into that center because all three win when the healthcare universe begins to orbit its new center of gravity. In this universe, “insurance” is no longer the dictator of care and cost but simply one more piece of a collection of services ordered toward a new priority. There is a roadmap to a new “healthverse” and it is quietly reforming around its proper center.

Stay tuned. Lots more to come.

  • Trish+Berry


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